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P. 1 <br /> Communication Result Report ( Oct, 15. 2014 P204PM ) <br /> Fax Header) <br /> Date/Time : Oct. 15. 2014 1 :58PM <br /> File Page <br /> No, Mode Destination Pg (s) Result Not Sent <br /> ---------------------------------------------------------------------------------------------------- <br /> 2138 Memory TX 94683433 P. 8 OK <br /> RECEIVED <br /> OCT 17 2014 <br /> ENVIRONMENTAL <br /> DEPARTMENT <br /> ---------------------------------------------------------------------------------------------------- <br /> Reasonfor error <br /> E. 1) Hang up or line fail E. 2) Busy <br /> E. 3) N o a n s w e r E. 4) N o f a c s i m i l a c o n n e c t i o n <br /> E. 5) Exceeded max. E—mail size <br /> Sao JOAOtmf CoaaTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> InE s Een HN,00-Armns,slooMan.CdM.a 95205-0232 <br /> Teapfroee:(HN)48&3420 iIX:( 4Re�433(Yeti: <br /> RETURN TO COMPLIANCE CERTIFICATION <br /> Any MINO111 violation;noted hn the to Cary'ht the asiNfed impection ROW rm et be <br /> wrn,Na!wiftNt dare of mcolpt of ftls aspeetion.Thin narf(o9tion form must be submithed to the <br /> roymmental Health Department(EHD)gess at the top of this form within 30 daps of rece"of ern, <br /> Inspection Report.HSC 25404.1.2(c)(1) <br /> AN 0200clIEWS 10 COW M111191111 noted In ser inspection Report(IR)err Continuation Fom,or <br /> disputes to any violations,ere to be submitted mft this n te on aretaned to EHD within 30 dors <br /> unless to specified in s Inspection Report.HSC 25185(0)(3) <br /> Note:AS EHD staff Snre associated avidh falling to comply by the about noted dates will be <br /> blMd at the currant hourly raft. <br /> For this certification to be complete the eperafor of the fife must edtate: <br /> •A statement documenting what comecfive wWom were taken or will be taken for each Yiolsson <br /> •Copies of temple appropriate Impervmk adfor photos <br /> wenrrn®corrections <br /> •Operator's certification <br /> Mspectten Mato;August 20,2014 Inspected gy:Arf VVeloso <br /> Facility Addriess:1020 S.Beckman Road Em m. CAL000391454 <br /> I certify under ppb of law that <br /> t. I here corrected the vidafom specified in fa Inspection Report from the abovelventloned <br /> Inspection date. <br /> 2. 1 have pesomsy examined No following docutneestoo submitted as proof of compliance FOR <br /> EACH VIOLATION cud I/believe the to be tme, ,and wmgklQ ®n• <br /> Y photos papervAtnk Staamem <br /> 3. 1 om End odzed to submit due coif ellan on behalf of the Respomfont <br /> 4. 1 am aware that it.—rm ss(((er stnsicant penaNes for information,Inckoft the <br /> possibility of a1 laonrnre!tar kmLvn vin es 25191)���' <br /> Name: N /Niue: <br /> wm .��_�s✓ Date: <br /> erro�eaemsre.omans <br />